MEDICARE: MR. YAGNESH V PATEL R PH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051285899	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	051285899	OTHER	IL	PHARMACY LICENSE NUMNER

General Provider Information

NPI Number	:	1417311929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. YAGNESH V PATEL R PH

Provider Business Mailing Address
First Line	:	4125 ROYAL TROON CT
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60174-8714
Country	:	US
Telephone Number	:	630-777-2254
Fax Number	:	847-264-7300

Provider Business Practice Location Address
First Line	:	1780 WALL ST
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-5790
Country	:	US
Telephone Number	:	847-264-7100
Fax Number	:	847-264-7300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2016
Last Update Date	:	04/11/2016

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